Bariatric surgery can be a transformative step toward better health and a more fulfilling life for individuals grappling with obesity. This article delves into the role of diet pills and weight management strategies following bariatric surgery, providing a comprehensive overview for patients and healthcare professionals.
Understanding Bariatric Surgery and Its Impact
Bariatric surgery encompasses various procedures, including laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, and laparoscopic adjustable gastric banding (Lap-Band). These surgeries work by altering the anatomy of the digestive system to reduce the amount of food a person can consume and/or limit the absorption of calories. UT Southwestern bariatric surgeons have performed more than 4,000 minimally invasive procedures.
- Laparoscopic sleeve gastrectomy: This procedure removes approximately 90% of the stomach, leaving a smaller "sleeve" to hold and digest food.
- Laparoscopic Roux-en-Y gastric bypass: This surgery reduces the size of the stomach and bypasses a portion of the small intestine.
- Laparoscopic adjustable gastric banding (Lap-Band): This involves placing an inflatable balloon-type device around the stomach to restrict food intake.
Bariatric surgery is often considered a last resort for those unable to achieve results through diet and exercise alone. It has been proven effective in promoting significant weight loss, with patients losing 30-50% of their total body weight within the first 12 months. The average patient can maintain 50% of excess weight loss over five years. Beyond weight loss, bariatric surgery can also improve health conditions associated with obesity, such as type 2 diabetes, obstructive sleep apnea, and cardiovascular disease, and can even put these conditions into remission.
Nutritional Considerations Post-Surgery
Bariatric surgery affects how the body absorbs nutrients from food, and the same applies to medication. After the procedure, the digestive system functions differently, necessitating specific vitamins and supplements to ensure adequate nutrient intake. Your doctor may have you take specific vitamins and supplements to ensure you get all the nutrients you need.
Common supplements include:
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- Multivitamin: To cover a broad spectrum of essential vitamins and minerals.
- Vitamin D3: People need around 3,000 international units of vitamin D3 daily.
- Vitamin B12: Important for nerve function and red blood cell production.
- Calcium supplement: Crucial for bone health.
Patients may also need to take medications in different forms, such as liquid, chewable, sublingual (under the tongue), or injectable medications, to prevent them from getting stuck in the digestive system. Examples of medications that may be required in different forms include omeprazole and ursodiol.
The Role of Weight Loss Medications After Bariatric Surgery
Even after successful bariatric surgery, some patients may experience weight regain, typically occurring two years after the surgery and affecting around 25% of patients. In such cases, weight loss medications can be a valuable tool to manage weight and sustain the benefits of the surgery. Combining surgery with newly approved weight-loss drugs and a healthy lifestyle is proving especially promising in helping people who are morbidly obese (a BMI of 40+) maintain their weight loss. If you begin to regain weight or would like to lose more to hit your goal, discuss this with your weight management doctor during one of your appointments. They may suggest adding one of the weight-loss medications-usually about two years after surgery.
Types of Weight Loss Medications
Several weight loss medications are available, each working through different mechanisms:
- GLP-1 Receptor Agonists: These medications, including semaglutide (Wegovy, Ozempic, Zepbound) and liraglutide (Saxenda), mimic the effects of bariatric surgery by reducing appetite and promoting a feeling of fullness. They act like the gut hormone GLP-1 which is released after you eat, slowing down food movement. In 2023, a UTSW study led by Dr. Jamie Almandoz found that patients taking semaglutide lost an average of 12.9% of their body weight, while those taking liraglutide lost an average of 8.8%.
- Phentermine: This medication has been available since the 1960s and acts as an appetite suppressant. The weight loss can be 10-30 pounds.
- Phentermine and Topiramate (Qsymia): This combination medication can result in weight loss of up to 10% of body weight in clinical trials.
- Bupropion and Naltrexone (Contrave): This combination affects brain regions involved in appetite and reward. The weight loss in clinical trial is up to 10% body weight.
- Orlistat (Xenical, Alli): This medication inhibits the absorption of dietary fat. Orlistat has been shown to be modestly efficacious (120 mg three-times daily) in several long-term randomized clinical trials where it induced weight loss of approximately 5-10 pounds more than diet and exercise alone.
Considerations for Using Weight Loss Medications
- Timing: It is generally recommended to wait until the time of weight plateau after surgery before starting any weight loss medication.
- Individual Assessment: A healthcare provider can assess each patient and advise whether it is safe to start medication sooner or if waiting is a better option.
- Lifestyle Changes: Weight loss medications should only be used in conjunction with a healthy diet and exercise habits, not as a replacement for these lifestyle changes.
Benefits and Risks of Combining Bariatric Surgery and Weight Loss Medication
The potential benefits of combining bariatric surgery and weight loss medication include accelerated weight loss and improved weight maintenance over time. However, there are also potential risks, such as an increased risk of complications from bariatric surgery and an increased risk of side effects from weight loss medications.
Common Side Effects of Weight Loss Medications
The most common side effects of weight loss medications include nausea, constipation, diarrhea, dizziness, and headaches. In some cases, they can also increase blood pressure and cause heart palpitations and insomnia. Gastrointestinal issues are the most common side effect for people just starting to take GLP-1s for weight loss. This can often be minimized by beginning at a lower dose and gradually increasing.
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Long-Term Management and Support
Weight management is a lifelong process, regardless of the initial path to weight loss. For the best chance at sustainable success, partner with an obesity specialist to create a comprehensive, individualized plan. Patients who follow up for five years post-surgery have the best chance of maintaining the healthier weight they achieved.
The Role of Anti-Obesity Medications Before Bariatric Surgery
Anti-obesity medications can also play a role before bariatric surgery. They can help patients reach their pre-surgery weight goal quicker than with diet and exercise alone. To safely have bariatric surgery, patients are advised to first reach an optimal pre-operative weight or body mass index (BMI). Anti-obesity medications can help patients lose up to 20% of their body weight and qualify for surgery.
Nutritional Guidelines and Dietary Recommendations
Dietary recommendations are clearly spelled out for patients who have bariatric surgery, with plans customized to each patient’s needs. Nutritional guidelines do not currently exist for anti-obesity medications, but UTSW is leading the charge to give patients sustainable dietary recommendations.